Empowering Patients to Speak Up for Clean Hands


Christopher St. Clair, PharmD, ORISE Fellow and Clydette Powell, MD, MPH, FAAP, Director, Division of Health Care Quality, ODPHP

Every year, tens of thousands of patients die from infections they contract in hospitals — and at any given time, about 1 in 25 hospitalized patients have a health care-associated infection (HAI). Since the germs that cause HAIs are often spread by health care providers’ hands, proper hand hygiene is one of the most effective ways to prevent potentially deadly infections in health care settings.

Washing hands in sinkIf you work in health care, we’re probably not telling you anything you don’t already know. But what might surprise you is just how often health care providers aren’t following proper hand hygiene practices. The fact is that health care providers clean their hands less than half of the number of times they should.

Ultimately, it’s up to health care providers to make sure their hands are clean. But if that’s only working about half the time, it’s clear that we need to be thinking about other strategies, too. And many public health professionals agree that the most effective channel may be patients themselves.

That’s part of the idea behind Clean Hands Count, a campaign from the Centers for Disease Control and Prevention (CDC). The campaign is designed to encourage patients to take responsibility for protecting themselves, and others, by keeping their own hands clean and asking their health care providers to do the same.

A number of public health organizations, including the World Health Organization (WHO), have endorsed this strategy — and a review of literature on patient empowerment and hand hygiene found that encouraging patients to call out health care providers on their hand hygiene practices can increase handwashing compliance.

The review also found that the majority of patients are open to being involved in improving hand hygiene — but that more work needs to be done to engage them. So what’s next? Ideas to reach patients include arming them with information about the importance of handwashing — or even asking patients to wear badges that remind providers to clean their hands. We can also explicitly give patients the task of observing hand hygiene during their care by asking that they fill out survey cards indicating whether or not they saw providers wash their hands.

And what may be most important in the quest to empower patients to speak up when they see an issue with a provider’s hand hygiene practices to is to help them feel comfortable holding them accountable — and telling them so. We need to make it clear that it’s okay for patients to ask a provider to wash their hands — that it’s a good thing to say something like, “Would you mind washing your hands in front of me before you begin the exam?”

This National Handwashing Awareness Week is the perfect time to think about how we can improve hand hygiene practices in health care settings in order to reduce rates of HAIs. Let’s remember that a big part of that is figuring out effective ways to involve patients in that process. Like so many public health successes have shown, it’s forging and developing partnerships — rather than working alone — that’s going to help us get where we need to go.

Sample tweet: How can we engage patients to improve hand hygiene in health care settings? https://health.gov/news/blog/2016/12/empowering-patients-to-speak-up-for-clean-hands/ #HandwashingWeek #PreventionMatters